1. Measuring organizational readiness for change: an ongoing journey Bryan J. Weiner, Ph.D. Shoou-Yih Daniel Lee, Ph.D. Department of Health Policy and Management Gillings School of Global Public Health University of North Carolina at Chapel Hill

2. How did we define readiness? A two-dimensional construct reflecting organizational members’ collective commitment and collective efficacy to implement an organizational change –Collective commitment refers to organizational members’ shared resolve to pursue courses of action that will lead to successful change implementation –Collective efficacy refers to organizational members’ shared belief in their conjoint capabilities to organize and execute the courses of action required to implement change successfully Key features: – Capture both motivation and capability – Reference collective (organizational) versus individual readiness for change – Treat readiness as perceptual versus structural construct – Focus construct on implementation rather than on adoption

3. What did we want in our measure? Keep measure “pure” (exclude potential determinants) Balance generic versus specific item content (make it reusable) Give measure a specific change referent (differentiate from culture) Make measure group-referenced (focus on collective readiness) Develop something short and simple (8-10 items maximum)

4. What was our overall approach? Keep measure “pure” of potential determinants – Develop a conceptual model of organizational readiness for change – Work deductively rather than inductively to develop item pool Balance generic versus specific item content – Develop a broad item pool to capture many aspects of efficacy – Keep item wording general and put specifics in parentheses Give measure a specific change referent – Use instructions to direct people’s attention to specific change – Provide written synopsis of specific change Make measure group-referenced – Use instructions to direct people’s attention to reference group – Use item wording to direct people’s attention to collectivity Develop something short and simple – Create item bank to permit tailoring

5. What was our conceptual model? Organizational Readiness to Change Change commitment Change efficacy Resource Availability Human resources Financial resources Material resources Task Requirements Knowledge of task demands Knowledge of resource demands Knowledge of time/effort demands Situational Factors Competing demands Time availability Timing Change Valence Perceived need for change Relative advantage of change Appropriateness of change Implementation Effectiveness Consistency of use Quality of use

6. How did we proceed? Develop item pool from readiness/change management literature Conduct content adequacy test to check item-construct alignment Revise item wording/pool based on content adequacy test Conduct pilot test to check presumed factor structure and reliability ….Develop R21 proposal to move beyond pilot stage…. But then…..along came the “HTN Improve” study

7. How did we measure change commitment? Provide written description of program (with bulleted summary) Define “implementation group” and “user group” Measure perceived change commitment of implementation group: 1. Not at all2. A little3. Fairly4. Very5. DK –How committed is the implementation group to implementing this program? –How motivated is the implementation group to implement this program? –How willing is the implementation group to implement this program? –How much does the implementation group want to implement this program? Repeat in order to measure change commitment of user group

8. How did we measure change efficacy? Measure perceived change efficacy of implementation group 1. Not at all2. A little3. Fairly4. Very5. DK How confident are you that the implementation group can: –Effectively use the resources that are currently available to implement this program? –Encourage clinicians to try using this program (e.g., refer patients)? –Effectively coordinate the efforts of those involved in implementing this program? –Support clinicians as they adjust their clinical practice in response to this program? –Effectively solve problems that might arise in implementing this program?

9. Where are we going? Innovator Broker Producer DirectorCoordinator Monitor Mentor Facilitator Source: Quinn, RE. (1988) Beyond Rational Management. San Francisco: Jossey-Bass. Internal Process Human RelationsOpen Systems Rational Goal

10. What are some sample items? 1. Not at all2. A little3. Fairly4. Very5. DK How confident are you that the implementation group can: –Develop an effective strategy or plan for implementing this change? (director) –Keep the momentum going in implementing this change? (producer) –Hold people accountable for implementing this change (monitor) –Coordinate tasks so that implementation goes smoothly? (coordinator) –Support people as they adjust to this change? (mentor) –Get people involved and invested in implementing this change? (facilitator) –Improvise when problems arise implementing this change? (innovator) –Manage the politics of implementing this change? (broker) Working on developing 2-3 items per change management role/task

11. Want more information? Bryan Weiner, Ph.D. Department of Health Policy and Management Gillings School of Global Public Health University of North Carolina at Chapel Hill Bryan_Weiner@unc.edu 919-966-7375